CHILDCARE

Published: 19/05/2005, Volume II5, No. 5956 Page 35

Dr Tamara Everington, member of the British Medical Association's junior doctors' committee and a specialist registrar in haematology at University College London, says it is time for the NHS to get serious about childcare provision

NHS childcare facilities are designed to meet the needs of the last century. It is time for us to upgrade to a new model that comprehensively addresses the needs of working parents, allowing them to be an effective part of the workforce.

We know that medicine is going through a process of 'feminisation'.

Women now account for a quarter of consultants, half of house officers and three in five new medical students. By 2012, most doctors will be female. At the same time there are more graduate entrants to medical school than ever before and the hours that doctors can legally work have been reduced by the European working-time directive.

The fact that male doctors will soon be in a minority does not in itself give the whole picture. Demand from men for flexible working is far higher than ever before. It may not be a surprise that most female registrars hope to work less than full-time in the future, but more significant is that four in 10 male registrars also want this.

Both men and women want a better work-life balance, and social norms are shifting so men are increasingly taking on a pro-active role in childcare. And while mothers are still usually the primary carers, they are now returning to work when their children are younger. In 1981, less than a quarter of mothers returned to work before their child's first birthday. By 2001, the figure had risen to over two thirds.

Not every doctor is going to put their career before their family, so the strategic importance to trusts of providing both flexible working and better childcare is obvious. On the first front, the new contract for doctors in flexible training, agreed by NHS Employers and the BMA in March, will do a huge amount to encourage trusts to take on flexible trainees. On the second, there is a long way to go.

Recent government investment in the NHS childcare strategy - coupled with assurances from ministers that they recognise the importance of childcare - are encouraging.

Unfortunately for doctors, the strategy has failed to address the fact that both patients and families need services round the clock. Where NHS nursery care is available - and for doctors it often is not - it is open only in the daytime. Schools' working days and holidays do not match up with doctors' working patterns and very few trusts offer pre or after-school facilities or holiday clubs.

As part of the BMA's research into childcare I have been gathering opinion and data from doctors around the country.

Here are some of their comments:

'I work [in a children's hospital] where there are no childcare facilities at all.'

'There is not much flexibility on nursery sessions, I may end up paying for two fulltime places even though I am working 50 per cent.'

'Unfortunately having a child doesn't seem to be an option when you're in fulltime medicine, so my childcare will be provided by me going part time.' One doctor had a story to tell that reflects just how bad current childcare facilities are for doctors: 'The hours at the nursery are long - 7am until 7pm. When I said 'thank goodness, I need three long days', I was told that was impossible and my child could either start early and finish early (around 3pm) or start late and finish late.

'When I pointed out that I did clinics that did not finish in the middle of the afternoon, I was told that was too bad; they were the rules. I was also told by them that to leave a child in that long was wrong, implying that I was a bad mother for even thinking about it.'

Childcare services in the NHS are woefully lacking. The solutions may not be easily achievable without more funding and a major cultural shift, but other countries have proved that the needs of patients and families are not irreconcilable.

The option for 24-hour childcare exists for doctors in Scandinavia and the US, where it is possible to pursue the career of your choice without feeling guilty that you are not doing the best for your children.

This should be the ultimate goal for the NHS, but there is much that could be done in the short term. We need to collect data to establish the scale of the problem.

We need to know how many NHS staff have children and how many are cutting their hours or leaving because of childcare difficulties.

A cost-benefit analysis of 24-hour childcare provision must be made across the whole health economy. And in the immediate future the NHS must make a policy response to the rapid dissolution of childcare co-ordinator positions.